"Our staff is time constrained and it is hard to get them away from patient care to improve their patient care." More than 75 infants die each day in the United States. JCAHO estimates that 2/3 of cases of neonatal death or permanent disabilities during childbirth are attributable to human factors such as communication problems. We have developed a standardized Curriculum for simulated Obstetric emergency Response Drills and Safety (CORDS) that allows teams to rehearse OB emergencies and provides best evidence crew resource management (CRM) team training. It is unlikely that all CRM techniques equally impact clinical safety. When critical hospital personnel are already overextended, as reflected by the opening quote from a small rural hospital CEO, it is important to evaluate which elements are critical to safe processes of care. The main goal of this proposal is to evaluate the clinical impact and durability of simulations and team training in everyday clinical obstetric practice. Specifically we aim to: 1) Evaluate which elements of team training (CRM) are associated with good teamwork at the "sharp end" of everyday clinical practice in routine and emergency OB care 2) Translating research into practice (TRIP): Evaluate which elements of team training translate from performance in the simulated environment (research/bench) to the clinical environment (practice/bedside). To examine this aim we will: a) Evaluate associations between team performance and CRM elements in simulation and compare whether they are consistent with findings in clinical practice (AIM I) b) Explore which elements of CRM are transferable, durable and sustainable in the clinical environment 3) Explore the use of IT to create a safety culture that includes a critical but often silent team member - the patient. The results of this project will: 1) distinguish which CRM elements are essential to routine practice versus emergencies; 2) provide insights regarding the transferability and sustainability of simulation and team training in everyday clinical practice; 3) provide administrators and policy-makers important information regarding return on investment from simulation and team training; 4) evaluate safety from the patient perspective; and 5) optimize simulation and team training. Our current work evaluates performance in the simulated environment; this proposal focuses on the translation of simulation and team training to the clinical environment. [unreadable] [unreadable] [unreadable]